AB0207 SOME TARGET JOINTS PERSIST SWOLLEN ACROSS THE FOLLOW-UP IN RHEUMATOID ARTHRITIS: RESULTS FROM A REAL LIFE REGISTRY
Authors: E. Buschiazzo, M. Aciar, E. Picco, M. B. Lecumberri, N. Cucchiaro, A. C. Ralle, L. N. Belbruno, M. E. Crespo Espindola, V. Juarez, R. Rojas Tessel
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) is an inflammatory chronic disease, affecting peripheral joints. For the assessment of these joints, rheumatologists use mostly 28 joint swollen and tender count. Although there has been a development of new drugs and therapeutic strategies, there is new information (1) regarding the persistence of some joints that seem to be refractory to treatment. Objectives The aim of this study is to describe the pattern of swollen joint affection and its change during followup in real-life RA patients from a rheumatology clinic registry. Methods RA patients from an outpatient registry were included if they fulfilled ACR-EULAR 2010 criteria, had ≥ 18 years old, and attended between October 2010 to September 2021. Only those who a 28-joint swollen count available performed by an experienced rheumatologist (EB) in ≥ 5 visits were included. Each joint from the 28-joint count was analyzed individually, the percentage of swollen affection at baseline, last registered visit and during the follow-up was registered. Descriptive statistical analysis and comparisons was performed, depending on the type of data and its distribution. Results 403 patients with RA diagnosis were in the registry, 247 (61%) had descriptive 28-joint count, from which 154/247 (62.3%) had ≥ 5 visits and were finally included. When comparing those with &lt; 5 with ≥ 5 visits, the latter had more bDMARD/tsDMARD treatment at baseline (16.9% v 6.5%, p = 0.01). In 154 patients, the mean period between visits was 6.7 months (SD +/- 5.8), the mean follow-up was 5.8 years (SD +/- 3.1), and the mean of visits per patient was 13 (DS +/- 8.8). At baseline the most affected swollen joints were 35.7% right wrist, 35.1% Left Wrist, 35% 2nd right MCP, 32.5% 3rd right PIP. At the last registered visit, the same joints were the most affected, and the percentage of affection persisted across the follow-up. [Figure 1]. When the change from baseline to the last registered visit was analyzed for other variables, a significative improvement was found (baseline v last visit, ESR-DAS28: 3.8 v 3, p = 0.0001, CRP-DAS28: 3.5 v 2.7, p = 0.001). Figure 1. Percentage of swollen joint affection at baseline, final registered visit and average followup Conclusion In this registry, some swollen joints were persistently affected across the follow-up, and did not improve from baseline to the last registered visit. However, the burden of the disease improved, measured by DAS28 or its individual components. The improvement of other swollen joints and other components of DAS28 can be the reason. The detection and local treatment (vg: intra-articular injections) of this persistent swollen joints could be the better approach to this issue. Weaknesses of this study: a possible bias in the included patients (they were from single clinic), joint assessment not blind and performed by a single rheumatologist, patients included could be more severe since they were more frequently bDMARD/tsDMARD users. References [1]Heckert S, Bergstra SA, Matthijssen X, et al POS0097 JOINT INFLAMMATION TENDS TO RECUR IN THE SAME JOINTS DURING THE RHEUMATOID ARTHRITIS DISEASE COURSE Annals of the Rheumatic Diseases 2021;80:259. Table 1. Change from baseline to the last registered visit (n = 154) VARIABLE Basal Final p = Methotrexate – n (%) 89 (57.8) 119 (77.3) 0.0001 Leflunomide – n (%) 31 (20.1) 37 (24) 0.3 Prednisone – n (%) 57 (37) 75 (48.7) 0.01 bDMARD / tsDMARD – n (%) 26 (16.9) 49 (31.8) 0.0001 Swollen Joints – X (SD) 4.64 (4.8) 3.03 (3.8) 0.0001 Tender Joints – X (SD) 3.9 (4.5) 2.49 (3.6) 0.002 VAS global (mm) – X (SD) 38.5 (24) 31.04 (22.7) 0.004 VAS physician (mm) – X (SD) 35.6 (26.4) 24.2 (22.4) 0.0001 ESR (mm/1h) – X (DS) 33.7 (23.2) 27.3 (23.2) 0.01 CRP (mg/dl) – X (DS) 3.7 (5.7) 1.7 (2.6) 0.02 ESR-DAS28 – X (DS) 3.8 (1) 3 (1.1) 0.0001 CRP-DAS28 – X (DS) 3.5 (1) 2.7 (1.1) 0.001 ESR-DAS28 ≤ 2.6 – n (%) 22 (14.3) 50 (32.5) 0.0001 2.7-3.2 – n (%) 16 (10.4) 16 (10.4) 1 3.3-5.1 – n (%) 78 (50.6) 43 (27.9) 0.0001 ≥ 5.2 – n (%) 9 (5.8) 8 (5.2) 0.8 Disclosure of Interests None declared